ECG of the Month: 75-Year-Old Man With Acute Increase in Dyspnea and Chronic Cough

The patient is 75-year-old man with history of end stage renal disease, heart failure with reduced ejection fraction (HFrEF), s/p TAVR for moderately severe aortic stenosis, paroxysmal atrial fibrillation, and s/p left atrial appendage closure device due to GI bleeding, who was admitted to hospital because of acute increase in dyspnea and protracted cough. He was diagnosed with acute on chronic heart failure and troponin at 0.34 [normal < 0.11 ng/ml].

The following ECG was performed (Figure 1):

Figure 1

Figure 1

The ECG shows which of the following:

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